Provider Demographics
NPI:1225114994
Name:RITCHIE CARDIOLOGY PC
Entity Type:Organization
Organization Name:RITCHIE CARDIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMA
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WADDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-450-5568
Mailing Address - Street 1:PO BOX 5077
Mailing Address - Street 2:4031 S WEBSTER ST
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46904-5077
Mailing Address - Country:US
Mailing Address - Phone:765-450-5568
Mailing Address - Fax:765-450-5569
Practice Address - Street 1:4031 S WEBSTER ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-6911
Practice Address - Country:US
Practice Address - Phone:765-450-5568
Practice Address - Fax:765-450-5569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01049560A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E56457Medicare UPIN
221860Medicare PIN
E56457Medicare UPIN